An Escape from Loneliness
The quotation from Jung on the previous page is a reminder that loneliness often comes from ‘being unable to communicate the things that seem important’ to us. This ‘loneliness-in-proximity’ is liable to affect healthcare practitioners as much their patients, perhaps more so. American physician and author, Abraham Verghese, wrote this of practitioners:
“We trust our colleagues, we show propriety and reciprocity, we have the scientific knowledge, we learn empathy, but we rarely expose our own emotions.”
From The Tennis Partner
Though it is written with practitioners in mind, this section applies to every human being. We all have these challenges in one form or another.
So what is the answer?
In his wonderful book, The Renewal of Generosity – Illness, Medicine and How to Live Arthur W. Frank writes that, “Medical care both sets and reflects standards for caring relationships between individuals in society. By this overused word care, I mean an occasion when people discover what each can be in relationship to the other.” Fundamental to this is generosity, and “generosity begins in welcome: a hospitality that offers whatever the host has that would meet the need of the guest… To guests who suffer, the host’s welcome is an initial promise of consolation. If the cosmic creation of life is the founding act of generosity, the human gift of consolation has at least one analogous quality: no reciprocity is required, for indeed none may be possible”(quotes p2-4). This gives us all a chance to offer a model for a more caring society whilst caring better for ourselves .
What does it take?
It takes a kind of loving. The English are squeamish about this – we have only one word for love. This causes confusion. The Ancient Greeks had six words. The kind of loving we are talking about is closest to what the Greeks called Agape. In recent times this word has been adopted by Christianity to mean the love of God, and translated as Charity. In the context of the current crisis of caring in the 21st century we desperately need another word to stand for the reverence for life in all its forms, often called deep ecology or reverential ecology. We need a deep caring for and about another sentient creature. There is no doubt that this can emerge between doctor and patient.
How do we do it?
So we welcome our guest. Then we listen. We listen first to what the other says – to their words. As American family therapist, Harold Goolishian, advised: “Don’t listen to what patients mean, listen to what they say.”[refLauner] This is echoed elsewhere including in the above Arthur Frank book (p37). This amounts to the medical conversation (and any other conversation) becoming a dialogue, allowing true connection with the other. Whereas, consecutive, perhaps overlapping, monologues perpetuate fragmentation [refBohm]. Central to dialogue is suspending judgment. This is a key part of Buddhist-derived mindfulness. It has been built into the very successful Acceptance and Commitment Therapy (ACT) developed within the discipline of clinical psychology [ref column]. This forward-looking method is a blend of science, creative art and Buddhist practice.
Creative artists, like clinicians, first pay concentrated attention, then create a representation. The starting place needs to be ‘not knowing’. Conceptual artist, Emma Fisher, puts this well: “Not knowing is not experience stripped clean of knowledge, but a mode of thinking where knowledge is put into question, made restless or unsure. Not knowing unsettles the illusory fixity of the known, shaking it up a little in order to conceive of things differently.” [ref On Not knowing how artists think p131].
“Creativity is knowing what to do when the rules run out, or there are no rules in the first place.”
“The task of attention goes on all the time and at apparently empty and everyday moments we are ‘looking’, making those little peering efforts of imagination which have such important cumulative results.”
“Don’t listen to what patients mean, listen to what they say.”
The power of touch
Below is an extract from A Fortunate Man – the story of a country doctor by John Berger with photographer, Jean Mohr. It is based on their close observations of the English country doctor, John Sassall. This passage illustrates many of the points made on this page.
“[H]e is acknowledged as a good doctor because he meets the deep but unformulated expectation of the sick for a sense of fraternity. He recognizes them. Sometimes he fails – often because he has missed a critical opportunity and the patient’s suppressed resentment becomes too hard to break through – but there is about him the constant will of a man trying to recognize.
‘The door opens,’ he says, ‘and sometimes I feel I’m in the valley of death. It’s all right when once I ‘m working. I try to overcome this shyness because for the patient the first contact is extremely important. If he’s put off and doesn’t feel welcome, it may take a long time to win his confidence back and perhaps never. I try to give him a fully open greeting. All diffidence in my position is a fault. A form of negligence.’ It is as though when he talks or listens to a patient, he is also touching them with his hands so as to be less likely to misunderstand: and it is as though, when he is physically examining a patient, they were also conversing.”
To be continued….